Current patient-reported outcome measures are heavily dependent on English, which present serious language barriers to deaf and hard of hearing (DHH) patients who use American Sign Language (ASL). The availability of patient-reported outcome measures in ASL and English and such that is valid for users of accessible technology and services will provide important insights on improving prevention and treatment models that will lead to better personal and public health within the underserved DHH population. The research plan builds on Dr. Kushalnagar's prior research on communication and quality of life outcomes with deaf and hard of hearing (DHH) population. Communication-related fatigue is relevant to healthcare outcomes. Specific aims include (1) describing the linguistic and internal validity of PROMIS-Deaf profile, (2) examining QoL domains across DHH sub-groups, and (3) evaluating the prevalence of communicative stress and risk factors for health status and generic QoL in a nationwide sample of early-deafened adults. The study will be conducted by a research team that includes: an early career investigator with expertise in quality of life outcomes in DHH population, a senior investigator with expertise in patient reported outcome measures (the creator of the FACIT fatigue QoL measure), a psychometrician with experience in conducting IRT and psychometric analyses for patient reported outcome measures, an audiologist with expertise in (re)habilitative audiology and hearing related outcomes, an ASL translation expert, and a biostatistician. The Advisory Committee consists of experts on the subject matter related to the project and who are nationally known for their work with DHH population. Results from this study will provide a better understanding of the mechanisms that may contribute to poor quality of life frequently observed for individuals with hearing loss. The goals of this application are consistent with the NIDCD 2012-2016 strategies related to improving outcomes for human communication and reducing health disparities, and expected findings will support the development of a future grant proposal for a randomized study that will assess the ability of PROMIS- Deaf profile to detect minimally important changes with intervention.